- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $144.54 / $263.03
| Professional | | $97.72 | $144.54 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $194.98 / $524.81
| Professional | | $102.33 | $194.98 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $186.21 / $295.12
| Professional | | $165.96 | $186.21 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $162.18 / $323.59
| Professional | | $79.43 | $162.18 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $128.82 / $269.15
| Professional | | $75.86 | $128.82 | $269.15 |